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Takayasu’s arteritis (TA) is a chronic granulomatous vasculitis with yet unknown etiology that affects the aorta and its main branches leading to progressive arterial stenosis. Neurovascular complications occur in less than 20% of patients with TA; however, they are a major source of morbidity in these patients.1 Low incidence of the disease, especially when presenting with atypical symptoms, can considerably delay the correct diagnosis and treatment. Attacks of focal neurologic deficits due to fluctuating brain ischemia may be difficult to distinguish from other neurologic disorders, especially relapsing and remitting multiple sclerosis, considering the demographic predominance of both disorders in young women. We present a 36-year-old woman referred to our department after the second attack of left hemiparesis. She experienced the first attack of left-sided weakness 4 months before. Examination at the time revealed left hemiparesis accompanied with left hemihypesthesia, upward left plantar response, and unremarkable general examination. She was apparently normal before these attacks, and reported no vascular risk factors. At the first admission, she was diagnosed with multiple sclerosis based on a brain magnetic resonance imaging (MRI) evidence of multiple foci of gadolinium-enhancing and non-enhancing white matter lesions in bilateral periventricular and subcortical areas (Figure 1, a and b), and negative workup for systemic vasculitis autoantibodies, anti-human immunodeficiency viruses (HIV) and human T-cell leukemia virus type 1 (HTLV-1) serum antibodies, and normal serum acetylcholine esterase and vitamin B12 levels. Cervical MRI was unremarkable. A gradual improvement was evident after treatment with a 5-day course of pulse methylprednisolone, and she was discharged on interferon beta. At her second admission, she presented with another attack of left-sided weakness of grade 3 based on the Medical Research Council (MRC) scale accompanied with hemihypesthesia.

Recurrent ischemic stroke in a case of Takayasu’s arteritis, mimicking multiple sclerosis